Dr.Chirag Thakkar

Bariatric (Obesity) surgery in Elderly morbidly obese patients: Understanding the situation

Morbid obesity makes the quality of life poor. But in an elderly person, it is just crippling. Sometimes it becomes extremely difficult to do day to day activities on their own. Needing help even for self-care. Many a time bariatric surgery is not considered just because of their age. Actually, this is the people where it has the maximum advantage and can be done quite safely if done with all due precautions.

Problems faced by Elderly Obese people

As we all know Obesity brings a lot of problems. These problems are health problems, mobility problems, social as well as economic problems. All these problems, especially health problems and mobility problems are very severe in the elderly population.

Young obese vs elderly obese

Young people still have a lot of reserves in them to fight these problems. Hence you will see a lot of young obese people, who can well manage their life and do not have many health problems despite their weight. Most of the time it is because age is on their side. But even in young people also obesity is causing damage to different body systems, which are not apparent from outside. When the damage exceeds a certain point then it is apparent in the form of different problems. Our body has significant reserves and hence problems are not apparent till almost 70–80 % of the damage is done. This applies to most of the body organs, be it liver, heart, kidney or your knee. On the other hand, we see a lot more problems in elderly obese patients even at a comparatively lower weight.

Body pain and mobility problems

A very significant problem for them is their knee, hip and back pain problems. The joint and bone problems make it difficult to do many basic activities independently. This is even more so for elderly females who are obese. The problem worsens in case they have a fall and break their bones (have fracture). Surgery becomes risky and recovery is slow. Rest in the post-surgery period increases the weigh and the joint pain also increases due to surgery. All this creates a vicious cycle, which is difficult to break. The same also applies to elective surgery for knee and back problems. This is the reason why many orthopedic surgeons would suggest bariatric surgery before planned knee or back surgery. Many a time, the need for knee or back surgery is gone after weight loss. And in case it is still needed, the outcomes and recovery are much better.

Urinary Incontinence and Hygeine problems

Elderly female patients also have stress urinary incontinence (a condition that makes it difficult for them to hold back urination till they reach the toilet), which affects their personal hygiene. It also leads to repeated urinary infections and the need for repeat long course of antibiotics. The inability to maintain good hygiene also leads to persistent bad smell. It affects the person’s dignity and instills a fear to go out and be socially active.

Obesity related diseases

Apart from mobility issues, the other medical problems like diabetes, hypertension, breathing problems, and varicose veins problems are also very common. All these problems are common in elderly people, and if they are obese all these problems get worse and out of control. Sugars and blood pressure remain high in spite of a higher dose of medications. When these problems are poorly controlled, they lead to some more major problems like heart attacks, kidney and liver failure. All this is seen much more commonly in elderly obese patients compared to elderly people with normal weight.

Quality of life

Old age is supposed to be filled with peace and fun, but the above problems make it a constant struggle. Struggles for the patients themselves, as well as for the family. The family, even with all their efforts and care are unable to improve the situation for them. Weight loss brings a drastic change in the above-discussed scenario. With adequate weight loss, half of the problems just vanish and rest becomes easily manageable.

Incidence and burden in Indian population

The data from the US shows that about 30-35 % of elderly people above the age of 65 are obese. We don’t have an official Indian data, but even we have an estimated 15-20 % of elderly people who are obese and it is increasing rapidly with time. With the increasing burden, it a high time we get aware of the increasing problem. There is a strong need to take steps to prevent these problems at an early stage. There is also a need to be aware that once a person is in this situation, a good outcome can be achieved by a sustained weight loss with the help of Bariatric (Obesity or weight loss) surgery.

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Why surgery is needed

Bariatric surgery is not needed for all obese persons. But for may obese patients there is no better option left than a Bariatric surgery. With the joint pains, weaker muscles, lower energy levels they are just not able to bear their own weight. Exercising hard to lose weight is almost impossible and dieting alone does not work. If timely intervention in the form of bariatric surgery is not taken, soon their weight escalates and they become bed or chair bound.  And then the problems just multiply.  

Aditionaly, treatment of many of the above medical conditions is also more difficult due to obesity. It applies to treatment of diabetes, hypertension, varicose ulcers and also for knee replacement and liver or kidney transplant surgery. And hence many a time a bariatric surgery is advised before surgery for many medical conditions. For example, bariatric surgery is advised before knee replacement or kidney or liver transplant in case of obesity. Without weight loss, the outcomes of these surgeries would be compromised and hence the need.

What are the outcomes of bariatric surgery in elderly obese people

The sustained weight loss that comes with Bariatric surgery improves most of the medical problems faced by these patients. Hence the treatment of their medical problems becomes easier. The diseases remain under control and major problems are prevented.

Yes, it is true that bariatric surgery is a major surgery. Like all major surgeries, bariatric surgery also has its own risks. The risks are more in elderly patients and patients with multiple medical problems. But it is also true that when done with due precautions and in a standardized manner, these risks can be significantly reduced. Bariatric surgery is being done in elderly patients very commonly with great results. And the benefits of this surgery far outweigh its risks.

Apart from this, the mobility increases significantly and the problems of knee and back pain improve markedly. It becomes possible for the patient to take care of themselves.